围手术期病人休克早期识别与预防  

Early recognition and prevention of perioperative patients with shock

作　　者：石岩[1] 翁利[1] 杜斌[1] 

机构地区：[1]北京协和医院,北京100032

出　　处：《中国实用外科杂志》2014年第2期111-114,共4页Chinese Journal of Practical Surgery

摘　　要：休克是急性循环功能衰竭导致组织灌注不足和细胞氧利用障碍的一种临床综合征,是围手术期病人常见的严重并发症,病死率较高。早期识别及预防是迅速启动复苏并改善预后的重要措施。低血压作为传统诊断指标,往往提示休克进入失代偿期。越来越多的证据表明,即便对于病情复杂的休克病人,床旁细致的体格检查,特别是意识(淡漠、烦躁等)、尿量和皮肤(肢端温度降低、花斑、紫绀等),联合实验室检查(如高乳酸血症),有助于休克的早期发现。目前,尽管缺乏临床试验证实,但高危病人评估、完善术前准备、术中严密管理及术后加强监测等综合措施有望降低围手术期并发症(包括休克)的发生率。Shock is the clinical syndrome of circulatory failure that resuhs in tissue hypoperfusion and inadequate cellular oxygen utilization. Shock is associated with high morbidity and mortality in patients during perioperative period. Early recognition and prevention are crucial to prevent organ dysfunction and/or failure as well as to improve clinical outcome.＇ Systemic arterial hypotension, as a conventional parameter, often becomes evident until decompensation phase of shock. A large body of evidence suggested that tissue hypoperfusion based on clinical evaluation, hemodynamic profile, and biochemical tests （e.g. hyperlactatemia） may help early identification of compensatory shock. Clinical signs have been shown to be an early marker of inadequate tissue perfusion, which are apparent through the three ＂windows＂ ： neurologic （altered mental state, which typically includes obtundation, disorientation and confusion）, renal and cutaneous （skin that is cold and clammy, cyanosis）. Despite the lack of evidence-based effective measures, a muhifacet strategy including recognition of high-risk patients, better preoperative preparation and appropriate perioperative management remains the cornerstone of shock prevention.

关 键 词：围手术期 休克 体格检查 乳酸 酸中毒 

分 类 号：R6[医药卫生—外科学]